Deep Brain Stimulation Helps Severely Depressed

(HealthDay News) -- For those with the most severe depression, a novel therapy may offer new hope.

The treatment is deep brain stimulation (DBS), which is used for some people with Parkinson's disease, and researchers found that it cut depression symptoms by 50 percent for about half of those treated.

"This is a new therapy for patients with severe, intractable depression. There's a lot of promise for this approach," said study author Dr. Ali Rezai, director of the Center for Neurological Restoration at the Cleveland Clinic in Ohio.

Deep brain stimulation requires minimally invasive surgery to place electrodes into specific parts of the brain that are believed to be malfunctioning. Once in place, the electrodes emit tiny, adjustable, electrical pulses that block dysfunctional activity in the brain. It's been used for about 20 years in the treatment of Parkinson's disease. Rezai added that the current group working on DBS and depression, which includes researchers from Brown University and Massachusetts General Hospital as well, has also had success using DBS to treat obsessive-compulsive disorder.

Severe depression occurs in about 10 percent to 20 percent of depression cases, according to Rezai. Antidepressants, and even electroconvulsive (ECT) therapy, often fail to bring about improvement in depressive symptoms for those with this severe form, leaving them at an increased risk of suicide. The suicide rate in people with major depression may be as high as 15 percent, according to the researchers.

In the current study, 15 people suffering from severe depression for at least five years who weren't helped by other forms of treatment received DBS implants. Six months later, 47.1 percent had at least a 50 percent reduction in their depressive symptoms, based on a commonly used depression scale. At one year, that number was 50 percent.

Even patients who didn't meet the 50 percent reduction criteria used as an endpoint in this study still experienced some symptom reduction, according to Rezai, who added that all of the participants said they would undergo DBS again.

The procedure was well-tolerated, and just one patient had a brief seizure in this study.

"This is not for everyday depression, but for those who have failed everything else, hope is on the way," said Dr. Kathryn Holloway, a professor of neurosurgery at the Virginia Commonwealth University Medical Center in Richmond. "There are new treatments being developed that are having success where no medication has," she noted. Other treatments that have shown promise include vagal nerve stimulation and transcranial magnetic stimulation. The problem, she said, is that many insurers won't cover these procedures for depression.

Rezai was expected to present the findings April 29 at the American Association of Neurological Surgeons annual meeting, in Chicago. He said that his DBS group is now conducting a larger, controlled study.

Another depression study being presented Monday at the meeting found that people on medications for clinical depression who underwent surgery for a malignant brain tumor, called an astrocytoma, had an increased risk of death after the surgery.

Depression prior to surgery upped the odds of death after surgery by about 40 percent, according to the Johns Hopkins School of Medicine study. At 12 months after surgery, just 15 percent of those who were depressed before their operation were alive, compared to 41 percent of those who weren't depressed. At 20 months, none of the depressed patients were still alive, yet 21 percent of the non-depressed were still alive. The authors concluded that effectively treating depression before surgery might help improve outcomes.

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Life Without Email? Wassup, Doc?

So a diabetic walks into an endo's office and says, "Hey Doc, can I get your email address in case I have any follow-up questions?" And the doctor replies, "Sorry, we do medicine, not email."
I made that up myself. No, really... I did.

But don't laugh too hard. There is actual proof now that doctors who are willing to email with their patients are a rare breed indeed. I'm very lucky to have found one -- well, a few actually -- here in the tech-savvy SF Bay Area who were willing to take the plunge. Why isn't email contact with your healthcare provider more common across the country, what with it being so darn convenient, and let's face it, pretty much the lifeblood of the business world these days? In many ways, email functions as our portal to the world, no?

What's standing in the way is primarily fear, apparently. Fear of being overwhelmed by yet one more responsibility, of not being reimbursed for time spent answering emails, of patient privacy concerns, and of course, of legal liability if patients are unhappy with email interaction, or if anything said there should result in negative health consequences. Fair enough. Those are legitimate concerns.

But electronic communication is now a fact of life. It's used for virtually ever other aspect of commerce in this country. "People are able to file their taxes online, buy and sell household goods, and manage their financial accounts," says Susannah Fox of the Pew Internet & American Life Project. "The health care industry seems to be lagging behind other industries." Ya think?
But doctors will continue to resist as long as they have no support on the concerns mentioned above. So once again, all arrows seem to point back to the need to reform our healthcare system, in this case to address and support the way people interact in this century.

Oddly enough, the pharma industry hasn't wasted too much time finding ways to use email to reach out to doctors -- bombarding them with "ePromotions," and more recently, electronic drug alerts. Meanwhile experts have been touting the benefits of email to the physician-patient relationship since the year 2000 at least. But doctors are still holding back, for all the practical reasons mentioned (read the comments on that post).

According to this story ("It's no LOL"): "It's not the first time the medical field has been slow to embrace technology. When the first telephones became widely available in the late 1800s, doctors were concerned about being swamped with calls." But the medical establishment is expected to come around on the email issue eventually. Hmm, I wonder how many more decades before they embrace Social Media?

So, how many of you actually exchange emails with your doctors? I can't tell you how happy it makes me to receive my lab slips as an email attachment in two minutes, rather than waiting for them to arrive via Snail Mail, and then misplacing the envelope. Even my daughters' pediatrician sends me quick replies, usually with a nice side query as to how we're all doing. How lucky are we?

Chinese Ants Show Promise in Fighting Arthritis, Other Diseases

(HealthDay News) -- Substances found in a type of Chinese ant may provide anti-inflammatory and painkilling benefits against several diseases, a new report says.

Chemists analyzing extracts from a Chinese medicinal ant, Polyrhacis lamellidens, found two polyketides, potent natural products that other studies have deemed as promising treatments for arthritis, bacterial infections and many other diseases. Polyketides are also found in plants, fungi and bacteria.

The findings, published in the April 25 issue of American Chemical Society's Journal of Natural Products, support Chinese folk medicine's practice of using ants as a health food or drink ingredient to treat conditions such as joint pain or hepatitis.

Researchers have long suspected this is due to substances in the ants, but the exact chemicals responsible for the medicinal effects have largely been unknown.

More information
The National Center for Complementary and Alternative Medicine has more about alternative treatments for rheumatoid arthritis.

Embryonic Stem Cells Turned Into Three Types of Heart Cells

(HealthDay News) -- A multinational team of researchers has succeeded in turning human embryonic stem cells into three types of human heart muscle cells.

When transplanted, the cells also improved heart function in mice.

The findings have a number of implications, the most immediate of which would be to use the cells to test drugs.

"We have now a supply of human heart cells for biotech and drug companies to start testing the beneficial effects of drugs or the toxic effects of drugs," said Gordon Keller, senior author of a paper published in this week's issue of Nature. "There are really no roadblocks in beginning to set up such tests."

Researchers may also be able to use the cells to make artificial heart tissue, which could then be transplanted into an actual human heart.

"It's not clear how effective injecting cells directly into the heart ever will be," said Keller, who is director of the McEwen Centre for Regenerative Medicine at University Health Network in Toronto. "A huge advantage we have is that these unique progenitor cells can make three of the major types of cells in the heart, so we hope we can simply seed these progenitor cells onto scaffolding and make what might be an artificial piece of heart tissue and possibly transplanting such small pieces of tissue, and engrafting them into the heart, would be more effective than transplanting the cells themselves."

Keller's lab had previously succeeded in coaxing cardiac cells out of mouse embryonic cells.

For this study, the team used similar principles, applying specific growth factors at different stages of development, but in human embryonic stem cells.

"They're showing that different 'recipes' can induce different types of cardiac cells," said Paul Sanberg, director of the Center for Aging and Brain Repair at the University of South Florida College of Medicine in Tampa.

In this way, the researchers were able to isolate heart progenitor cells then coax them into three different types of heart cells, called cardiomyocytes, which make up functioning heart muscle.

"Now we have our hands on a cell that doesn't have the same developmental potential as embryonic stem cells but can still make three of the major types of heart cells," Keller explained. "When we have these cells in isolation, we have a better handle on directing their pathway to cells that beat, or other [cardiac] cells. That's much more difficult when we haven't isolated the cells."

Also, when these cells were transplanted, they didn't form tumors, which often happens when a group of cells is more mixed. "In essence, we have isolated the most immature human heart cells, and we think we can control these cells much better than we would if we were starting with embryonic stem cells," Keller said.

The findings will help researchers better understand how the heart develops in humans, but therapeutic applications are still a ways off.

"It's important that we understand the basic biology," Sanberg said. "But it's still going to be a while till we see this in the clinic."

More information
The National Institutes of Health has more on stem cells.

Health Tip: If You Have to Take Iron Supplements

(HealthDay News) -- If you are anemic or need iron supplements for another reason, taking the pills can be difficult.

The American Academy of Family Physicians suggests how to make taking iron supplements a little easier:

• Take the pills with food.


• Gradually work your way up to the number of pills your doctor prescribed each day. Start out with one a day, then after three to five days, begin increasing the amount until you've reached the daily dose recommended by your doctor.


• If iron pills make you constipated, add fiber to your daily diet.


• If the pills make your stomach upset, don't take them before you go to sleep.


• If a particular brand causes problems, ask your doctor about different brands or formulas.

Filling in the Alzheimer's 'Race Gap'

(HealthDay News) -- A diagnosis of Alzheimer's disease is wrenching, especially for family members of the patient.

But certain races and ethnic groups, including Hispanics and blacks, are more likely to labor under misconceptions about the disease, often wrongly viewing it as a normal part of aging, researchers are learning.

And that often leads to delays in seeking care, when early treatment might make a difference in the progression of the mind-wasting disorder.

In a recent survey conducted for the Alzheimer's Foundation of America, researchers found that Hispanic and black caregivers were more likely to believe that the symptoms of Alzheimer's weren't a disease but just part of growing old. Thirty-seven percent of black caregivers and 33 percent of Hispanic ones thought that was the case, compared to 23 percent of caregivers from other racial or ethnic groups.

Black and Hispanic caregivers were also more likely to say they did not know much about the disease.

The results of the survey highlight the need for more education about the disease, so all Americans can be given the chance to get appropriate treatment, experts said.

Eric Hall, founding chief executive officer of the Alzheimer's Foundation of America, called the survey results "distressing," adding, "Lack of an early diagnosis leaves families at a point of chaos and crisis, wondering, 'How do I care for my loved one?' "

"In the absence of a cure, care becomes a critical issue to sustain the highest quality of life for the longest time," Hall said.

The impact of Alzheimer's affects different groups of people differently in many ways, explained Angela Geiger, vice president of constituent relations for the Alzheimer's Association. For instance, she said, the disease is more prevalent among blacks than whites, and Latinos are more likely to exhibit symptoms earlier.

Given these differences, organizations such as the Alzheimer's Foundation of America and the Alzheimer's Association have created programs and other resources to reach out to different populations. For instance, publications on warning signs and other information about the disease are available in Spanish and in English, Geiger said.

"We've created a series of culturally appropriate publications tailored to African-Americans and Latinos," she said.

Alzheimer's disease affects more than 5 million Americans, according to the Alzheimer's Foundation of America, and that number is expected to rise to 8 million by 2030 as the population ages. It's currently the seventh leading cause of death in the United States.

So, what can people do to recognize the disease earlier and get help for a loved one? Educating yourself about the symptoms is one way. Both the Alzheimer's Foundation of America and the Alzheimer's Association offer information about the disorder on their Web sites. That information includes specifics on the differences between normal aging -- for instance, forgetting a word now and then -- and symptoms of Alzheimer's -- forgetting the name for common objects and calling a toothbrush "the thing for my mouth," for example.

"I think, overall, that the nation at large has a very poor understanding of what dementia is," Hall said.

If you suspect a loved one is in the early stages of Alzheimer's, Geiger suggests that you reach out for assistance and guidance. Ask your loved one's health-care provider for an evaluation, for starters.

"Work with your health-care provider to get that diagnosis as early as possible, because there are things you can do," she said, adding that behavioral interventions and medicines are two options.

More information
To learn more about Alzheimer's disease, visit the Alzheimer's Foundation of America.

New Psoriasis Pill Appears Effective

(HealthDay News) -- A new drug for patients with moderate to severe psoriasis appears to be safe and effective, a Canadian trial shows.

The results indicate higher doses of ISA247, which is a calcineurin inhibitor, significantly improve symptoms of psoriasis. Calcineurin is a protein that helps regulate inflammation.

"This is the first oral medication in 20 years to show promise for the treatment of moderate to severe plaque psoriasis," said lead researcher Dr. Kim Papp, from Probity Medical Research in Waterloo, Ontario.

The new drug is safer and easier to use than current treatments for psoriasis, the researchers said.

Psoriasis is an autoimmune skin disease. The most common form, plaque psoriasis, appears as raised, red patches or lesions covered with a silvery white buildup of dead skin cells. As many as 7.5 million Americans have psoriasis, according to the U.S. National Institutes of Health.

Currently, one of the most effective treatments for psoriasis is the calcineurin inhibitor drug ciclosporin. However, the drug's toxic effects on the kidneys prevent it from being used for long-term treatment, which is often needed because psoriasis tends to reappear once treatment is stopped.

Other drugs such as infliximab (Remicade) are safe and effective but are expensive and inconvenient to use. In addition, the long-term safety of the drug isn't known.

The report is published in the April 19 issue of The Lancet.

In the study, Papp's team randomly selected 451 patients with plaque psoriasis that affected at least 10 percent of the body, to receive the new drug or placebo. There were three groups of patients who received ISA247, but at different doses.

The researchers looked for a 75 percent reduction in what is called the psoriasis area and severity index score (PASI 75).

Papp's group found that after 12 weeks of treatment, 47 percent of patients who received the highest dose of ISA247 achieved PASI 75. Patients receiving lower doses achieved a 25 percent or a 16 percent improvement in their PASI score. Among patients in the placebo group, only four of 115 achieved PASI 75, the researchers reported.

"ISA247 is a reasonable oral medication for the treatment of psoriasis," Papp said. "It is reasonable because of reasonable efficacy, high tolerability and minimal metabolic effects."

In addition, because the effect of the drug correlates with its dose, it "can be titrated to suit patients response and tolerance without undue risk of adverse effects," Papp said.

One expert thinks the result of this trial needs to be duplicated in longer-term studies, and it needs to put in a head-to-head comparison with other psoriasis drugs.

"ISA247 may offer advantages compared with ciclosporin," said Dr. Luigi Naldi, from the Unit of Dermatology and GISED Study Centre at Ospedali Riuniti di Bergamo, Italy, and author of an accompanying editorial. "However, its efficacy and safety profile needs to be further evaluated in the context of longer-term comparative studies."

Naldi noted that these trials need to be done in real-life situations. In addition, the trial done by Papp is too short to really tell whether or not the drug is safe, since most patients taking the drug would have to use it for a long time to control their psoriasis, he said.

"The risk of chronic kidney toxicity induced by calcineurin inhibitors increases with treatment duration and cannot be reliably predicted with short-term data," Naldi said." An obvious comparator in the ISA247 trial would have been ciclosporin. Without such an internal comparison, the claim that ISA247 is safer than ciclosporin should be viewed cautiously, because it is based on external comparisons," he said.

More information
For more on psoriasis, visit the U.S. National Library of Medicine.

Talk Therapy Proves Effective for Terminal Cancer Patients

(HealthDay News) -- Talk therapy can help treat depression symptoms in patients with terminal cancer, according to Japanese researchers who reviewed the results of six studies that included a total of 517 patients with incurable cancer and depression.

The primary type of depression treatment for these patients was supportive expressive group therapy, in which they were encouraged to discuss their deepest fears and feelings and to help each other cope with them.

The review authors found that the benefits of this kind of treatment were only slightly less than those found in clinical trials of antidepressant drugs in general patient populations.

"Psychotherapy can be a promising treatment for ameliorating depressive states in advanced cancer patients if they prefer to receive it," said review lead author Tatsuo Akechi, an associate professor of psychiatry and cognitive-behavioral medicine at the Nagoya City University Graduate School of Medical Sciences.

However, Akechi and his colleagues found that psychotherapy did not significantly improve patient anxiety. This may be because there were too few patients to give enough statistical power to demonstrate an effect, Akechi suggested.

The researchers didn't examine whether psychotherapy could improve survival or response to cancer treatment. The review appears in the current issue of the journal The Cochrane Library.

"The key finding is that psychotherapy for depression for gravely ill cancer patients works," David Spiegel, associate chair of psychiatry and behavioral sciences at Stanford University School of Medicine and an expert on therapy in cancer patients, said in a prepared statement. He wasn't involved in the review but was one of the lead investigators on one of the studies included in the review.

Spiegel said that many doctors don't look for depression in patients with advanced cancer, or they consider it a normal and untreatable response among dying patients. Spiegel noted that only about 25 percent of patients with terminal cancer suffer depression due to their situation, which is different than the grief, sadness and anger associated with the thought of dying.

"Depression and existential dread or sadness is not the same thing. Patients with depression feel hopeless, helpless and worthless. They feel like a burden to others," Spiegel said.

More information
The U.S. National Cancer Institute has more about depression.

Health Tip: Talking to a Person With Alzheimer's Disease

(HealthDay News) -- As Alzheimer's disease progresses, communicating becomes more of a challenge.

The U.S. National Institute on Aging offers these suggestions for talking to someone with Alzheimer's:

• Speak in a calm, soothing tone of voice.


• Use simple, short words and sentences -- but avoid baby talk, or speaking like you would to a child.


• Avoid talking about the person in front of him or her.


• Turn off the TV, radio or any other possible distractions when trying to communicate.


• Get the person's full attention before speaking, and refer to the person by name.


• If the person is trying to communicate but is having trouble finding words, gently try to suggest words the person may be looking for.


• Be patient and give the person plenty of time to think and respond.

Testosterone Spray Improves Sexual Satisfaction in Women

(HealthDay News) -- Testosterone spray slightly improved sexual satisfaction in premenopausal women, but a placebo had the same effect, a new study reports.

Researchers look at 261 women, aged 35 to 46, who were treated at six medical centers in Australia. The women, with self-reported low libido and low serum-free testosterone levels, were randomly assigned to receive one of three different doses of a testosterone spray or a placebo daily for 16 weeks.

At the end of that time, all the women reported increased frequency of sexually satisfying events. The difference between the testosterone spray and the placebo was statistically significant only for women who received the middle dose of testosterone.

The researchers found that 81 percent to 86 percent of women in the testosterone groups and 70 percent of the women in the placebo group reported adverse side effects. The most common was hair growth on the abdomen, where the testosterone was sprayed.

The study was published in the April 15 issue of the Annals of Internal Medicine.

In an accompanying editorial, Dr. Rosemary Bassone, of the University of British Columbia in Vancouver, wrote that women's testosterone levels and libidos may decline as they age, but that doesn't mean the lack of testosterone is linked with sexual dissatisfaction.

"We do not have a fully satisfactory rationale for testosterone therapy," and there is a "lack of long-term safety data," Bassone wrote.

Instead of prescribing testosterone for women with sexual dissatisfaction, doctors should examine health and relationship issues, sexual dysfunction in the partner, and treat problems using conventional methods such as cognitive behavioral therapy, sex therapy and psychotherapy, Bassone recommended.

More information
The American Academy of Family Physician has more about female sexual dysfunction.

Drinking May Raise Breast Cancer Risk

(HealthDay News) -- Alcohol, consumed even in small amounts, increases the risk of breast cancer and particularly estrogen-receptor and progesterone-receptor positive breast cancer, a new study shows.

The findings, expected to be presented Sunday at the annual meeting of the American Association for Cancer Research, in San Diego, are followed by a second study that found an association between breast cancer risk and two genes involved in alcohol metabolism.

Previous data has suggested that consuming alcohol ups the risk of breast cancer, although the precise mechanisms have not been clarified.

In some forms of breast cancer, malignant cells have receptors that render them sensitive to hormones such as estrogen. The first study aimed to see if the hormone receptor status of the tumor influenced the relationship between alcohol consumption and breast cancer risk.

In the study, a team led by Dr. Jasmine Lew of the U.S. National Cancer Institute followed more than 184,000 postmenopausal women for an average of seven years.

Those who had less than one drink a day had a 7 percent increased risk of breast cancer compared to teetotalers, the team reported. Women who drank one to two drinks a day had a 32 percent increased risk, and those who had three or more glasses of alcohol a day had up to a 51 percent increased risk.

But the risk was seen mostly in those 70 percent of tumors classified as estrogen receptor- and progesterone receptor-positive. Researchers suspect that alcohol may have an effect on breast cancer via an effect on estrogen.

The risk was similar whether women consumed primarily beer, wine or spirits, the NCI team noted.

The second study dug deeper into other possible mechanism by which alcohol consumption increases breast cancer risk.

"For years, we've known that there's an association between alcohol drinking and breast cancer risk, but nobody knows yet what the underlying biological mechanisms are," said Dr. Catalin Marian, lead author of the study and a research instructor in oncology at the Lombardi Comprehensive Cancer Center at Georgetown University in Washington, D.C. "The logical step was to begin analyzing the alcohol metabolizing genes."

And indeed, two of these genes -- ADH1B and ADH1C -- were associated with a two-fold increase in breast cancer risk.

But the study does not prove a definite cause-and-effect link. "This is an association," Marian said. "This type of study is good for generating hypotheses. It's not a definite conclusion. It needs to be replicated by other studies to say for sure that what we found is there."

Another researcher urged caution in interpreting the results of both studies.

"These studies are too early for use in a clinical setting or to advance a public health message," said Dr. Peter Shields, co-author of the genetics study and deputy director of the Lombardi Comprehensive Cancer Center.

However, he added that the findings "really do advance science, and, with proper replication in other studies, then they may be highly clinically significant."

More information
There's more on breast cancer at the U.S. National Cancer Institute.

Male Contraception: Progress Slow but Steady

(HealthDay News) -- For now, men who want to do their part for birth control have meager choices: A vasectomy -- meant to be permanent -- and condoms.

For years, experts have predicted that male contraception is under development and that more choices will be here soon.

But when? Experts agree it's still a ways off, but it's getting closer.

"It has been slow," said Dr. Ronald Swerdloff, a researcher in the quest to find feasible male contraceptive methods. But there are good reasons for that slow pace, added Swerdloff, an endocrinologist and chief of the division of endocrinology at Harbor-UCLA and professor of medicine at the Harbor-UCLA Medical Center in Los Angeles.

Pharmaceutical companies are reluctant to take on a new product quickly because of untested liability issues, he said. And "one of the biggest single issues has to do with the fact that contraception in general is a difficult area it would be used by large numbers of healthy individuals." The safety threshold, he noted, is high. Still, he added, more options are moving closer.

"If we really focus on studies, with funding, it could be four or five years" before more options might be available, said Elaine Lissner, director of the Male Contraception Information Project, a San Francisco-based organization.

The problem, she added, is that the research has been scattergun. "If we [continue to] do a study here, a study there, as we have for the last 20 years, it could take forever."

At a "Future of Male Contraception" conference, sponsored by the U.S. National Institutes of Health in Seattle, a variety of methods were reviewed, including:

• Hormonal therapy and testicular warming -- Swerdloff and his team found that giving men testosterone and another hormone with testicular warming helped suppress sperm. "The transient testicular warming [like sitting in a spa] causes the suppression to occur much earlier [than the hormones alone]," he said.
• Transdermal gels -- In another study by Swerdloff's team, 140 men applied either a progestin gel called Nestorone or a testosterone gel, or both. The researchers studied various doses and then drew blood samples to measure hormone levels. They reported on the 119 men who complied and finished the study, concluding that the combination worked better to suppress sperm.
• "Intra Vas Device," or IVD -- An alternative to a vasectomy, this method involves inserting silicone plugs into the vas deferens, the tube sperm move through and the same tube cut in a vasectomy. "The sperm can't get past the plugs," said Joe Hofmeister, president of Shepherd Medical Company in St. Paul, Minn., the IVD developer.
• "Preliminary six-month data show that 90 percent of 60 men [tracked to date] have zero motile sperm," he said. More study is needed to track the IVD for reversibility, Hofmeister said.
• Vitamin A blocker -- Columbia University researchers tested a drug abandoned by a pharmaceutical company because it interferes with vitamin A receptors in the testes, lowering fertility. It worked well in animal studies; whether it will do the same in human studies is not yet known.

These approaches, if successful, will take several more years to get market approval, all the researchers agreed.

More informationTo learn more about all available contraception methods, visit the U.S. National Library of Medicine.

'Worry' Spot in Brain Found

(HealthDay News) -- Stanford researchers report that worrying about something before it happens might do more than just create knots in your stomach.

They found that people who seemed to have higher levels of "anticipatory worry" -- judged by brain scans of activity in a part of the brain known as the anterior insula -- did better in a financial game, said study author Gregory Samanez-Larkin, a psychology graduate student at Stanford.

If the anterior insula was more active, the subjects had "a higher fidelity when it comes to making economic decisions," said Samanez-Larkin. "They were better at predicting what might happen." These volunteers learned to avoid losses when playing the same game months later, he noted.

"I wouldn't call it intelligence," he said. Instead, "it's a sort of expertise."

The anterior insula is a region buried deep inside the brain that's considered an artifact of humans' reptilian heritage. "At the very basic level, it has something to do with sensing danger or monitoring danger," explained Rajesh Miranda, an associate professor at Texas A & M Health Science Center.

But researchers haven't spent too much time on that region, because they prefer brain regions that are easier to access and understand, he said.

In the new study, Samanez-Larkin and colleagues recruited 23 subjects to play a financial game while scanners measured their brain activity. Eight to 10 months later, the subjects returned and played a similar game, although their brains weren't scanned.

The researchers then tried to find links between the brain scans and how the subjects performed in the games. "We looked in the brain for readings that were active while people were anticipating losses" in the game, Samanez-Larkin said.

The results were published in the April issue of Psychological Science.

Miranda said the study doesn't add much to existing knowledge. "It seems like it deals essentially with what's been known," he said.

Still, expanded knowledge about that particular brain region could lead to better treatments for anxiety and help researchers predict who might do a better job of handling stress, Miranda said.

Samanez-Larkin said the research could also be used to detect people who are most likely to get too many credit cards and fall into debt or fall victim to scams, because they aren't adept at processing financial information. "You could identify people who are susceptible to things like this and try to help them," he said.

More information
Check out images of various brain regions at brainexplorer.org.

Atherosclerosis May Also Harm Vital Organs

(HealthDay News) -- New research indicates that the fatty plaques that harden arteries may also harm vital organs.

"Atherosclerosis is usually associated with plaque formation in arteries," said study author Rita K. Upmacis, an associate research professor in pathology and laboratory medicine at Weill Medical College of Cornell University in New York City. "But using a mouse model of atherosclerosis, we have demonstrated that the effects of this disease are more widespread, affecting . . . the heart, liver and lungs."

The finding, scheduled to be presented this week at the American Chemical Society annual meeting, in New Orleans, centers around the availability of nitric oxide (NO), an important gas within the body that relaxes blood vessel walls and helps prevent atherosclerosis. Certain substances in plaque remove NO and create a toxic substance known as peroxynitrite, which hampers the function of enzymes necessary to the health of blood vessel walls.

In the latest study, researchers found that in mice that were fed a high-fat diet and who developed atherosclerosis, peroxynitrite, nitrotyrosine and other substances that interfered with NO were common not only in the blood vessels, but also in the hearts, lungs and liver.

"During many disease states, reactive oxygen species such as superoxide are formed," explained Upmacis. "The problem here is that nitric oxide, which is beneficial to the body, reacts with superoxide, and forms something called peroxynitrite, which is a powerful oxidant that can cause all sorts of damage and wreak havoc. These reactions are predicted to lead to the vascular dysfunction encountered in atherosclerosis."

It is possible drugs could be developed to increase NO production and prevent organ damage from atherosclerosis. However, there could be unwanted side effects, such as an increased risk of infection, so it would be difficult to create a drug targeted specifically to atherosclerosis, Upmacis said.

Since nitrotyrosine levels can be detected in the blood, it may also be possible to one day develop a test that could both detect and track the development of atherosclerosis, the researchers added.

What about using statins to prevent organ damage?

Dr. John C. LaRosa, president of the State University of New York Downstate Medical Center, New York City, said it's a possibility.

"Statins improve flow rates in the kidney and may delay or prevent deterioration of kidney function in older adults," he said. "Statins also improve retinal [eye] blood flow in diabetics and may deter diabetic eye disease. These effects are currently under investigation, however, and are not current indications for statin use."

Dr. Alan Kadish, associate director of the Northwestern Cardiovascular Institute in Chicago, said when it comes to atherosclerosis, prevention is the best cure.

"At the present time, the best thing patients can do is understand that atherosclerosis can have bad effects, even some that are still being identified, and adhere to exercise, diet and lifestyle modifications that will decrease their risk of developing atherosclerosis," he said.

More information
For more on atherosclerosis, go to American Heart Association.

Health Tip: Swelling During Pregnancy

(HealthDay News) - Production of additional fluids and blood during pregnancy sometimes leads to swelling in the woman's face, hands, legs, ankles and feet.

Here are ways to help control swelling during pregnancy, courtesy of the American Pregnancy Association:

• Don't stand for long periods. Sit and rest with your feet elevated.


• Avoid hot temperatures.


• Wear comfortable, flat shoes with stockings that provide support.

• Wear loose-fitting, comfortable clothes.


• Relax in a pool, or swim a few laps.


• Drink plenty of water, and reduce the amount of salt (sodium) in your diet.


• Apply a cold compress to swollen areas.

A Month of Exercise Helps Ease Heart Failure

(HealthDay News) -- Just four weeks of moderate exercise is enough to boost the cardiac performance and breathing capacity of patients with heart failure, a new study finds.

This slightly more strenuous exercise program -- in standard use in Europe for people with heart failure -- works at least as well as the less intense American regimen, the researchers noted. They presented the findings Tuesday at the Experimental Biology conference in San Diego.

In heart failure, the heart progressively loses the ability to pump blood. In the United States, doctors typically recommend three-times-a-week exercise sessions for eight to 12 weeks to help ease the condition, noted study author Stephen F. Crouse, a professor of kinesiology and internal medicine at Texas A&M University, in College Station.

His team looked at data from an Austrian rehabilitation center where 366 heart failure patients (average age 63) exercised 14 to 22 minutes on stationery bicycles six times a week. Participants also did a brisk 45-minute walk each day.

Four weeks of that regimen were enough to produce a significant increase in the participants' breathing capacity, Crouse said.

"This is something that we can recommend continuing for the rest of their lives," he added.

The benefits of exercise for people with heart failure are well-established, Crouse acknowledged. "There are some data from U.S. studies showing that the European regimen has at least equal benefits," he said.

The study used such standard measures of heart function as VO2max, which measures oxygen consumed; resting heart rate; and blood pressure. But of greater interest was the measurement of blood levels of the protein NT-proBNP, which is secreted when heart muscle cells are stressed, Crouse said.

"We have this biomarker in the blood that can be followed very well and that correlates with [cardiac] performance," he said.

Levels of NT-proBNP went down as standard measures of heart performance went up, Crouse said. Blood levels of the protein dropped by 33 percent in the study group after four weeks of the exercise regimen.

Measuring NT-proBNP "is something we would suggest could become a routine clinical test, of treatment and performance," Crouse said. A blood test for the protein is not expensive and is a better alternative for more costly tests such as echocardiography, he said.

The longer-term effects of a continued exercise program for heart failure will be assessed by the Texas A&M team, Crouse said. "We need data to follow them out," he said.

The results were not surprising and will not affect advice on exercise now given to people with heart failure, said Dr. William E. Kraus, research director at the Duke University Center for Living. His center is currently leading a major trial of long-term exercise training for people with heart failure, with results expected later this year.

Use of NT-proBNP as a measure of performance is "a new wrinkle, but not so much of one that it makes me want to change practice," Kraus added.

More information

Guidelines for exercise in heart failure are provided by the Cleveland Clinic.

Too Little Sleep Leads to Too Much Weight for Kids

(HealthDay News) -- Babies who get less than 12 hours of sleep a day face twice the risk of being overweight as preschoolers.

And, some parents may inadvertently contribute to their child's sleep problems by taking steps intended to soothe the child that, in reality, lead to disrupted sleep.

That's the conclusion of two reports in April's special issue of the Archives of Pediatrics & Adolescent Medicine, which is devoted to children and sleep.

"The combination of too little sleep and too much TV is associated with markedly elevated risk of obesity," explained Dr. Elsie M. Taveras, an assistant professor of ambulatory care and prevention at Harvard Medical School and lead author of the first study.

For the study, Taveras and her colleagues collected data on 915 children whose mothers reported on their child's sleep habits during the first two years of life. Using this information, researchers were able to determine how much sleep the children had each day between 6 months and 2 years of age.

On average, the children slept 12.3 hours a day. When the children reached 3 years of age, 83 were overweight. The researchers found that 3-year-olds who slept less than 12 hours a day as infants weighed more for their age and sex, compared with children who slept 12 hours a day or more as babies.

Also, babies who watched two or more hours of television a day had a 16 percent increased risk of being overweight, compared to a 1 percent risk for babies who didn't watch TV, Taveras said.

"The combination of low sleep and high TV might be acting independently to be a higher risk for obesity," Taveras said. The explanation may trace to hormones that control appetite, she added.

In the second study, Valerie Simard, of the Hopital du Sacre-Coeur de Montreal and the University of Montreal, and colleagues found that parents' behavior at bedtime was linked to sleep disturbances of their children.

The researchers had the parents of 987 children fill out questionnaires about their children's sleep habits each year from the time the children were 5 months old until they were 6 years old. They found that sleep disturbances among very young children (5 to 17 months old) were primarily due to "maladaptive parenting behaviors," such as the mother being present when the child was going to sleep, or feeding the child after he or she woke up. And "co-sleeping" -- when a parent sleeps with a child -- was found to make it harder for a child to fall back asleep after awakening.

"Our findings clarify the long-debated relationship between parental behaviors and childhood sleep disturbances," the authors concluded. "They suggest that co-sleeping and other uncommon parental behaviors have negative consequences for future sleep and are thus maladaptive."

In another study in the journal, Australian researchers found that children with attention-deficit/hyperactivity disorder were more likely to have sleep problems than children without the disorder.

"Sleep problems in schoolchildren with ADHD are extremely common and strongly associated with poorer quality of life, daily functioning and school attendance in the child and poorer caregiver mental health and work attendance," wrote the researchers, who were headed by Valerie Sung, of the Centre for Community Child Health in Parkville.

"Implementation of a sleep intervention in children with ADHD could feasibly improve outcomes beyond treatment of ADHD alone. It is possible that such intervention could reduce the need for medication in some children," they added.

A fourth study, led by Alice M. Gregory of the University of London, found that children who get less sleep are more likely to suffer from symptoms of anxiety, depression and aggression later in life. Among 2,076 children studied, the researchers found that those who had sleep problems when they were 4 to 16 years of age scored higher on measures of anxiety, depression and aggressive behavior when they were 18 to 32 years of age.

"The results suggest that children reported to sleep for short periods may be at risk for later difficulties," the authors concluded.

One expert thinks that good sleep behaviors for infants are extremely important and need to be started early.

"We have to pay attention to the very early effects of sleep and health and eating in children. It probably does pave the way for a lifestyle, even in early childhood, that is going to be difficult to steer away from," said Dr. Ann Halbower, medical director of the Pediatric Sleep Disorders Program at Johns Hopkins University Children's Center in Baltimore.

Halbower thinks good sleep behaviors for infants need to be taught to parents before the child is born.

"If I meet with moms while they are pregnant and start discussing sleep behaviors, sleep routines, proper sleep habits and safe sleep for their child, they were much more likely to start that pattern than trying to change a behavior after it had become routine," she said.

More information
To learn more about children and sleep, visit the National Sleep Foundation.

One-Third of Dementia Cases Laid to Small Blood Vessel Damage

(HealthDay News) -- Small blood vessel damage caused by hypertension and diabetes may be among the leading causes of dementia, according to new research.

The findings provide an additional reason to control these common conditions, according to Dr. Thomas Montine of the University of Washington, who was to present the study Sunday at Experimental Biology 2008 in San Diego.

The autopsied brains of a third of men and women with dementia or cognitive decline showed evidence of small vessel damage -- a cumulative injury that can result from multiple small strokes caused by hypertension and diabetes. The strokes are often so small that the person notices nothing until the cumulative effect reaches critical mass, the researchers said.

Meanwhile, 45 percent of the risk for dementia was associated with pathologic changes of Alzheimer's disease. Another 10 percent risk was linked to Lewy bodies, which are neocortical structural changes that indicate a degenerative brain disease known as Lewy Body Dementia, a possible variant of Alzheimer's and/or Parkinson's disease, the study found.

The finding about small vessel disease challenges conventional wisdom and conclusions from most autopsy studies of brain aging and dementia, Montine said in a prepared statement.

The broader population sample on which the autopsy study was based may be reason for the differing results, he said. Most previous research had focused on participants in Alzheimer's disease center studies, or was limited to one gender, ethnic or professional group. The individuals in the new study were part of a large managed care program and representative of the Seattle urban and suburban area they came from: white, Asian, African-American and Hispanic, with a range of educational and professional levels.

In the study, which ran from 1994 to 2006, some participants suffered cognitive impairment and dementia, while others did not. Roughly a third of all 3,400 participants died, and autopsies were performed on the 221 who had given permission for this to be done.

More information
The American Heart Association has more about controlling high blood pressure.

Study Shows Anger Has Its Uses

(HealthDay News) -- People like to temper their emotions to the task at hand, and it can help them succeed, even if the emotions are not pleasurable ones, a new report suggests.

Individuals are motivated to increase their level of anger, for example, when they expect to complete a confrontational task in which anger might enhance performance, according to the study published in the April issue of Psychological Science. And reaching that frame of mind does seem to help.

Psychologists from Boston College and Stanford University told study participants that they would either play a computer game that is confrontational (a first-person shooter game where killing enemies is the primary goal) or one that is not confrontational (a game in which players guide a waitress serving customers). Participants then rated the extent to which they would like to engage in different activities before playing the game.

Participants preferred activities that were likely to make them angry (e.g., listening to anger-inducing music, recalling past events in which they were angry) when they expected to perform the confrontational task, researchers found. In contrast, participants preferred more pleasant activities when they expected to perform a non-confrontational task.

Angry participants proceeded to perform better than others in the confrontational game of killing enemy soldiers. However, they did not perform better than others in the non-confrontational game of serving customers.

"Such findings," the authors wrote, "demonstrate that what people prefer to feel at any given moment may depend, in part, on what they might get out of it."

More information
The National Crime Prevention Council has more about how to manage your anger.

Managing Stress Can Lower Heart Death Risk

(HealthDay News) -- Emphasizing an old adage, new medical research confirms that keeping stress levels under control can significantly reduce the risk of a heart attack or death in patients with coronary artery disease.

Although a correlation between stress and various heart ailments has been established in the past, this is the first observational study to examine the effect of anxiety or depression treatment on a heart patient's risk factors, according to lead study investigator Yinong Young-Xu of the Lown Cardiovascular Research Foundation in Brookline, Mass.

The research, which was to scheduled to be presented Tuesday at the American College of Cardiology's annual meeting in Chicago, examined 516 patients with coronary artery disease. Those who reduced or kept their anxiety level steady were as much as 60 percent less likely to have a heart attack or die compared to those who had an increase in anxiety level, the study concluded.

This ratio remained steady after adjusting for other potential cardiovascular risk factors including age, sex, education, marital status, smoking, hypertension, diabetes mellitus, previous heart attack, body mass index, total cholesterol, blood pressure, heart rate, ejection fraction and exercise treadmill test duration, the report said.

Patients were divided into three groups according to their baseline level of anxiety -- high, intermediate and low. Heart conditions in the study included irregular heartbeat (arrhythmia), atherosclerosis ("hardening of the arteries"), and atherothrombosis (blood accumulation leading to clotting).

Researchers asked patients about their feelings and moods, sleep patterns, irregularity in bowel or stomach functions and other stress markers. In addition to anxiety, the questionnaire also measured depression, hostility and physical complaints.

"These findings should reinforce to cardiologists a need to attend to the whole patient by paying attention to psychological problems in addition to cardiovascular disease," Young-Xu said in a prepared statement.

He added that the lifetime prevalence of anxiety disorder is around 30 percent among people with heart disease.

"If we can lower heart patients anxiety level, we may be able to reduce their risk of heart attack and prolong their life," he added.

More information
To keep your heart and your lifestyle healthy, visit the U.S. government for heart health advice.

Environmental Toxins, Radiation May Be Tied to Breast Cancer

(HealthDay News) -- In the decades following World War II, both breast cancer rates and the use of synthetic chemicals soared in the United States -- and a new report contends there's a strong connection between the two.

Produced by the Breast Cancer Fund, a non-profit group whose mission is to identify environmental links to breast cancer, The State of the Evidence: 2008 concludes toxic chemicals in the environment, along with increased radiation exposure, are the main culprits in the sharp rise of breast cancer incidence.

The report cautions that "in-utero" [in the womb] and early childhood exposure to carcinogens through plasticizers, estrogen-mimicking substances and other chemicals may increase the risk of breast cancer in adult life.

"As we looked at the research comprehensively, the themes of interactions of timing and mixtures of chemical exposures and also radiation exposure as risks emerged. In bringing this broad focus to environmental causes of breast cancer, we hope to find ways to lower the future incidence of breast cancer not only for adults but, most importantly, for our children and grandchildren," said Dr. Janet Gray, an endocrinology researcher at Vassar College, who edited the report.

However, some public health experts say there's no scientific proof establishing a link between environmental contaminants and breast cancer.

Based on a review of more than 400 breast cancer studies, The State of the Evidence noted that more than 80,000 synthetic chemicals are currently used in the United States, although complete toxicological screening data are available for only 7 percent of them. Many of these substances are known to remain in the environment for many years and accumulate in body fat and breast tissue.

One group of chemicals -- phthalates, which the Breast Cancer Fund report identifies as a breast cancer risk -- was in the news last week when the U.S. Senate passed legislation strengthening the Consumer Product Safety Commission with an amendment requiring all children's toys and child-care products to be free of these hormone system disruptors. A study by Fox Chase Cancer Center in Philadelphia last year found that phthalates accelerated breast development and genetic changes in newborn female lab rats, a condition that might predispose the animals to breast cancer later in life.

Exposure to chemicals that mimic estrogens in the body, called xenoestrogens, is thought to be the reason more girls are entering puberty at younger ages, according to Jeanne Rizzo, executive director of the Breast Cancer Fund.

In addition to phthalates, the new report lists other endocrine-disrupting compounds that the study authors say have been shown to affect the risk for breast cancer in humans, or the risk of mammary cancer in animals. Those compounds, according to the report, include:

• Pesticides such as DDT, dieldrin, aldrin and heptachlor; triazine herbicides
• Bisphenol, a chemical used to make plastics, epoxy resins and dental sealants
• Polyaromatic hydrocarbons (byproducts of combustion)
• Tobacco smoke
• Dioxins
• Alkyphenols (industrial chemicals used in cleaning products)
• Metals including copper, cobalt, nickel and lead
• Parabens (anti-microbials used in personal care products)
• Food additives such as compounds given to cattle and sheep to enhance growth

The report also cites environmental factors that may exert cancer-causing effects without hormone disruption. Those factors include exposure to the petrochemical solvent benzene; organic solvents used in the computer, furniture and textile industries; polyvinyl chloride (PVC) used in a variety of appliances, food packages and medical products; 1,3-butadiene, a byproduct of petroleum refining and vehicle exhaust; ethylene oxide, used in medicine and some cosmetics; and aromatic amines, byproducts of manufacturing plastics and dyes. Both ionizing and non-ionizing radiation are also listed as suspected cancer-causing agents, the report stated.

"The conclusions of the surveyed research show us we need to look earlier and earlier at the impact of chemical exposure in utero and early life and how toxins, radiation, genetic predisposition, diet, exercise and all those things interact together to increase breast cancer risk. The results of this study compel us to look at the need for broad public health policy reform and more federally funded research," Rizzo said.

In response to the report, Tiffany Harrington, public affairs director with the American Chemistry Council, said the chemical industry is seeking to better understand the complex relationship between modern chemistry and human health.

"The chemistry industry has contributed to endocrine research by supporting applied scientific studies focused on developing the datasets needed to evaluate the reliability of endocrine screening methods," she said.

Meanwhile, environmental medicine expert Dr. Jonathan Borak, an associate clinical professor of medicine at Yale University's School of Medicine, said a host of studies have found no clear link between specific toxins and breast cancer.

"So far, I have not seen any compelling evidence of a link between any environmental contaminants and breast cancer," he said.

More information
For more on breast cancer, visit the American Cancer Society.

Health Tip: Getting Up After a Fall

(HealthDay News) - If you fall, you can injure yourself even more just by trying to get back on your feet.

Here are suggestions on how seniors can pull themselves back up safely after a fall, courtesy of the American Academy of Orthopaedic Surgeons:

• Take a few deep breaths and don't panic. If you feel like you are hurt, call for help if there's someone close by. In any case, don't try to get up until you feel better.


• If you feel like you are not hurt, try rolling onto your side, turning your head in the direction you are rolling.


• Crawl over to a chair, couch or other sturdy piece of furniture, and slowly pull yourself up.
  Put your hands down flat on the furniture. Bend your stronger knee and keep the other knee on the floor, and slowly stand up.


• Slowly twist yourself around and sit down on the chair or couch. Call a family member or emergency services if you need help.

Are Too Many Women Getting Hysterectomies?

Benefits and drawbacks of full and partial hysterectomies.
by Ross Weale

Health magazine contributor Roshini Raj, MD, discusses treatment options for hysterectomies, endometriosis, and fibroids on NBC’s Today March 24.




DR. ROSHINI RAJ
Roshini Raj, MD, a Health magazine contributor and part of the magazine's Health Expert Network, is board-certified in gastroenterology and internal medicine with degrees from the New York University School of Medicine and Harvard University. Currently Dr. Raj is an attending physician at NYU Medical Center's Tisch Hospital in New York City. She also serves as an assistant professor at the NYU School of Medicine, and she has a special interest in women's health and cancer screening. She has also published several research articles on colon-cancer screening.

Dr. Raj has discussed health topics on numerous television outlets, including NBC's Today show, ABC's Good Morning America, CNN, FOX News, and Discovery Health. She has been quoted in publications such as the New York Times, the Wall Street Journal, Men's Health, Women's Health, and Fitness on the state of health care and other health news of the day. Dr. Raj is often called upon to explain and demystify complicated health topics.

Diabetics Face Doubled Risk of Heart Attack

(HealthDay News) -- Diabetics are more than twice as likely to suffer a heart attack, stroke and death from cardiovascular disease, putting them at the same risk level as non-diabetics who had previously suffered a heart attack, Danish researchers report.

The findings, appearing in April 1 issue of Circulation, led one study author to suggest all diabetics talk to their doctors about possibly starting treatments to control cholesterol levels and blood-pressure levels.

"We've talked about 'the lower, the better' for cholesterol and blood pressure to reduce the risk of heart attack," lead author Dr. Tina Ken Schramm, a research fellow at the Gentofte Hospital in Hellerup, Denmark, said in a prepared statement. "Now I think we should be saying the sooner, the better for primary prevention of cardiovascular diseases in diabetics."

The study analyzes patient and national registries for people aged 30 and older living in Denmark in 1997. Researchers found 71,801 people with diabetes and 79,575 who had a previous heart attack, then identified deaths and causes of death over five years.

"The increased risk was observed in people at all ages with either type 1 or type 2 diabetes who were receiving insulin or other drugs to reduce levels of sugar in the blood," Schramm said. "When people with diabetes do have heart attacks, they are twice as likely to die as non-diabetics."

The relative risk, or hazard ratio, of dying from cardiovascular disease was found to be 2.45 times greater for female diabetics compared with 2.62 times greater for women with a prior heart attack. The relative risk of dying from cardiovascular causes was 2.42 times higher in male diabetics; for men who had a prior heart attack the hazard ratio was 2.44.

When looking at heart attack, stroke or death from cardiovascular disease combined, men with diabetes faced a 2.32 higher risk while the risk rate was 2.48 for men who had at least one heart attack. For female diabetics, the combined relative risk was 2.48 while those with a history of myocardial infarction had a hazard ratio of 2.71.

The study did not look at patients on diet-only treatment for diabetes. The researchers also couldn't differentiate between type 1 and type 2 diabetes patients or adjust for common risk factors, including high blood pressure, high cholesterol, obesity, smoking, physical activity and blood glucose levels.

Type 2 diabetes, the most common form of diabetes, develops when the body doesn't make enough insulin and fails to efficiently use what insulin it does produce. In type 1 diabetes, the pancreas makes little or no insulin, requiring the patient to need daily doses of insulin.

More information
The American Diabetes Association has more about diabetes prevention.